Abnormalities of cleft patient can include midface hypoplasia, bony defect, oronasal fistulae, and malocclusion. Most of patients with unilateral cleft lip and palate have a Class III malocclusion with a degree of midfacial deficiency that warrants surgical correction. For cleft lip and palate patients, surgeons do bone graft at 6-9 years olds, and orthognathic surgery at 14-18 years old conventionally. The benefits of bone graft for cleft patient include the establishment of the maxillary segment continuity, elimination of residual oronasal fistulae, and support for alar base of the nose. In osteotomy of cleft patient, maxillary segment may have a poor or abnormal blood supply. In orthognathic surgery of cleft patient, relapse rate is greater than that of non-cleft patient. Also, the extent of a relapse tends to be higher. Orthognathic surgery of cleft patient without the previous bone graft has more difficulties than non-cleft patient because of oronasal fistula and bony defect. In these cleft patient cases, sequential orthognathic surgery after bone graft or distraction osteotomy or simultaneous orthognathic surgery and bone graft are performed for malocclusion and facial deformity. Each method has advantages and disadvantages. Therefore which method is more adequate is still debatable. In this article, we reported unilateral cleft palate patient who had simultaneous orthognathic surgery and iliac bone graft with reviews of literatures.